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New Flaker to Try Amevive First ... Lifestyle Questions
from Linda C.

Hello, Ed. Thank you for the information you are providing about psoriasis. 

My daughter developed psoriasis in 2000, at age 25. She is not into researching, so I am trying to help her.  She is to begin Amevive treatments March 22.  She hasn't received her CD+4 counts yet. Her Dr. also required a TB test, which was negative. Her only treatments prior to this, have been ointments and steroid shots in the elbows. Have you had any persons relate to you that when they began Amevive, they had not yet received any systemic treatments?  I am hoping this will be a benefit. 

The Dr. wanted to start Soriatane [acitretin] last year but that was postponed.  My daughter is the first patient her Dr. has put on Amevive. 

I would like very much to know if lifestyle affects psoriasis.  I know my daughter does not drink water. She is a soda junkie. She also smokes. And I know she has very dry skin. Nor does she exercise. When she developed psoriasis, she had changed jobs and her stress level was up. No one else in our family has it. Perhaps comparisons made could help others.  It is my hope that she can keep the arthritis at bay.  Are there any known factors that may cause the psoriasis to develop into arthritis?  Such as severity, length of disease, treatments, etc.? 

Sorry this is so long but anything that can help her and help others with psoriasis would be great. Sorry to hear about your CD+4 count being low and enjoyed reading your rebound diary. Thanks so Much. -Linda C.


Ed’s Response:  Hello Linda, thanks for writing.  Somewhere between 1 and 3 out of 10 people with P develop P Arthritis.  I think the range hasn't been narrowed because so many cases are misdiagnosed.  As far as I know, there is no way of predicting if a particular individual with P will also get PA.  When there is a family history the odds, naturally, change for the worse.

Does lifestyle effect psoriasis?  Probably.  As you know, there are two faces to the disease: proclivity and triggers.  Proclivity, we believe, is a genetic predisposition that we can't do anything about.  Triggers, on the other hand, can be difficult to ascertain and many of them (perhaps MOST of them) have to do with external stimuli (environment and lifestyle) or external stimuli that becomes internalized (stress, diet, smoking, drinking....). 

Almost every excess a human can obtain has been considered a psoriasis trigger.  Surely everything you've mentioned that could be criticized about your daughter's lifestyle has been thought to trigger P for some ... not drinking enough water, too much soda (too much sugar), smoking....  Dry skin may or may not trigger psoriasis, but it certainly exacerbates it!  Lack of exercise?  Yes, that too has been considered a trigger, especially as it relates to overall health and stress reduction.  Stress, of course, is constantly blamed.

Her derm's decision to try Amevive before your daughter has been on any systemic regimens doesn't surprise me at all.  The only reason so many people at FlakeHQ have tried other things before the biologics is that we PREDATE the biologics.  I imagine most adults who are just now "getting P" will be offered biologic therapies BEFORE things like methotrexate, cyclosporine and acitretin.  The reason is because, in theory, the biologics should be much safer — nothing about them is known to be toxic or to present other long-term risks (although it's too early to express confidence in any long-term prognostications).

Please don't let your daughter become too disappointed if Amevive doesn't work for her.  Anecdotally it appears that Amevive is the least effective of the biologic quartet currently available (Enbrel, Amevive, Raptiva, Remicade).  If she doesn't respond well to Amevive it does not mean she won't respond well to one of the others.

Let us know how things progress.  -Ed

P.S.  If for any reason your daughter or her doctor think again about using Soriatane, please make sure she reads all the literature online about that drug's awful consequences relating to pregnancy.  If my math is right, she's still of child bearing age.  If that's an issue, she may want to try anything else before she tries Soriatane.

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